Using Monte Carlo simulation to assess the value of combination vaccines for pediatric immunization

Research by vaccine manufacturers has resulted in the development of new vaccines that protect against a number of diseases. This has created a dilemma for how to introduce such new vaccines into an already crowded Recommended Childhood Immunization Schedule and prompted the development of vaccine products that combine several individual vaccines into a single injection. Such combination vaccines permit new vaccines to be inserted into the immunization schedule without exposing children to an unacceptable number of injections during a single clinic visit. This paper describes a Monte Carlo simulation with an integer programming model to assess and quantify the distributions around inclusion prices which reflect the economic premium of these new combinations. Each new vaccine competed against existing vaccines for six childhood diseases (hepatitis B, diphtheria, tetanus, pertussis, Haemophilus influenzae type b, and polio) at their March 2000 Federal contract discount prices.